Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block
O J Sletten, John M. Aalen, Hava Izci, Jürgen Duchenne, Espen W. Remme, C K Larsen, Einar Hopp, Elena Galli, Per Anton Sirnes, Erik Kongsgård, Erwan Donal, Jens U. Voigt, Otto A. Smiseth, Helge Skulstad
Abstract
OBJECTIVES: This study sought to investigate if contractile asymmetry between septum and left ventricular (LV) lateral wall drives heart failure development in patients with left bundle branch block (LBBB) and whether the presence of lateral wall dysfunction affects potential for recovery of LV function with cardiac resynchronization therapy (CRT). BACKGROUND: LBBB may induce or aggravate heart failure. Understanding the underlying mechanisms is important to optimize timing of CRT. METHODS: ). Sixty-four patients underwent CRT and were re-examined after 6 months. RESULTS: however, LV lateral wall work was substantially reduced (p < 0.005). There was a moderate overall correlation between LV lateral wall work and LVEF (r = 0.58; p < 0.005). In CRT recipients, LVEF was normalized (≥50%) in 54% of patients with preserved LV lateral wall work, but only in 13% of patients with reduced LV lateral wall work (p < 0.005). CONCLUSIONS: In early stages, LBBB-induced heart failure is associated with impaired septal function but preserved lateral wall function. The advent of LV lateral wall dysfunction may be an optimal time-point for CRT.